SI-BONE, Inc.

Worldwide revenue was $56 million, up 15.2% year over year. U.S. revenue increased 14.7% to $53.2 million, and international revenue increased 25.9% to $2.8 million. Gross profit rose 14.8% to $44.5 million, with gross margin at 79.5%. Net loss narrowed to $4.1 million, or $0.09 per diluted share, from $6.2 million, or $0.14 per diluted share. Adjusted EBITDA improved 178% to $2.8 million, with an adjusted EBITDA margin of about 5.1%. For 2026, SI-BONE raised revenue guidance to $231 million to $233 million from $230 million to $233 million, kept gross margin guidance at 79%, and said operating expenses at the midpoint of revenue guidance are expected to increase in the 12% area.

Laura Francis framed the quarter as evidence that SI-BONE’s core strategy is working: the company is extending its technology beyond the sacroiliac joint, adding new markets, and building a broader spinopelvic franchise around compromised bone. She emphasized the upcoming non-pelvic breakthrough device, the pipeline of additional programs over the next 18 months, and the company’s belief that 2027 could benefit meaningfully from new product adoption, new territories, and reimbursement changes. Her tone was optimistic and focused on long-term category expansion, but she repeatedly tied that optimism to existing commercial relationships and product differentiation rather than a broad market rebound.

Anshul Maheshwari highlighted the hard numbers behind the operating leverage: gross profit of $44.5 million, 79.5% gross margin, net loss of $4.1 million, and adjusted EBITDA of $2.8 million, with trailing-12-month adjusted EBITDA rising to $12.8 million. He said cash and equivalents ended at $145.9 million, up about $1.3 million sequentially, and noted another quarter of positive cash flow from operations. He also said the company expects higher-than-normal cash flow variability over the next two quarters because of headquarters build-out payments and tenant improvement reimbursement timing, while continuing to invest in surgical capacity and maintaining financial flexibility.

Analysts pressed on why the full-year revenue guide only moved modestly despite a stronger Q2, and management said it is using a measured approach because of third-quarter seasonality, the phased nature of the new product launch, and the lag before reimbursement changes show up in volume. Questions also focused on the third breakthrough device’s margin impact and commercialization; management said the launch should be efficient because the product targets an established call point, requires limited training, and should ramp quickly, though it will involve near-term depreciation on capacity investments. Other questions covered territories, utilization, and the Smith+Nephew partnership, with management saying hiring is accelerating toward nearly 100 territories, utilization should improve as new products launch, and the Smith+Nephew relationship is progressing with a normal onboarding cycle of around six months.